The Hospice Billing Specialist plays a critical role in maintaining the financial health of our hospice facility. This position is responsible for accurately billing Medicare, Medicaid, private pay, and other insurance providers for hospice services rendered, as well as managing room and board billing for inpatient and facility care. Attention to detail, a thorough understanding of Medicare and Medicaid regulations, and the ability to navigate complex billing systems are essential to success in this role.

Essential Job Functions/Responsibilities

Medicare/Medicaid and Insurance Billing

• Prepare and submit claims for hospice services in accordance with Medicare and Medicaid regulations.

• Accurately process and bill claims to Medicare, Medicaid, private payers, and other insurance providers, adhering to payer requirements and organizational policies.

• Review patient records to ensure accurate coding and documentation supporting billed services.

• Monitor claims for accuracy and completeness, promptly addressing discrepancies or issues.

• Follow up on unpaid or denied claims, resubmitting and appealing as necessary.

• Stay current with changes to Medicare, Medicaid, and other insurance billing regulations.

Room and Board Billing

• Manage room and board billing for patients receiving inpatient care at the hospice facility or other inpatient settings.

• Ensure accurate and timely invoicing of room and board charges to patients or their responsible parties.

• Collaborate with the intake or admissions team to verify patient information and ensure billing accuracy.

• Address patient inquiries regarding room and board charges, providing clear explanations and assistance.

• Work with insurance companies and third-party payers to facilitate payment for room and board services.

Documentation and Recordkeeping

• Maintain detailed records of all billing activities, including claims submitted, payments received, and outstanding balances.

• Document communications and interactions related to billing inquiries or disputes.

• Ensure compliance with HIPAA regulations, maintaining patient confidentiality.

Collaboration and Communication

• Collaborate with the interdisciplinary hospice team—including nurses, physicians, social workers, and administrators—to ensure accurate billing and documentation.

• Communicate effectively with internal stakeholders and external parties, including patients, families, insurance companies, and government agencies.

Continuous Improvement

• Identify opportunities to improve processes and increase efficiency in billing operations.

• Participate in training programs and continuing education to stay updated on industry best practices and regulatory changes.

Position Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration, finance, or a related field preferred.

• Previous experience in healthcare billing, with specific experience in Medicare billing preferred.

• Proficiency with billing software and electronic medical record (EMR) systems.

• Strong understanding of Medicare regulations and guidelines related to hospice billing.

• Exceptional attention to detail and accuracy in data entry and recordkeeping.

• Effective written and verbal communication skills.

• Ability to work independently and collaboratively in a dynamic environment.

• Strong organizational and time management skills.

• Familiarity with HIPAA regulations and patient privacy requirements.

Skills Required

1. Organization

2. Attention to Detail #IND2